多层螺旋CT灌注成像对单侧积水肾肾功能恢复预测的动物实验研究

Predictability of MSCT perfusion imaging in the restoration of renal function of hydronephrotic kidney in rabbits

目的研究MSCT灌注成像对单侧输尿管不全梗阻兔在梗阻解除后积水肾肾功能恢复程度评估中的价值。方法选用成年健康雄性新西兰大白兔24只,随机选取其中6只作为对照组行MSCT扫描。其余18只通过外科手术建立左侧输尿管不全梗阻积水肾模型,按梗阻时间不同随机分为3组(1周组,3周组,5周组),每组6只,分别于梗阻1、3及5周行MSCT扫描。随后解除梗阻,在同等条件下饲养3个月后再次行MSCT扫描。分别测量左肾皮、髓质的血流量(BF)和血容量(BV)值进行比较。然后各阶段处死一只实验动物,制作病理切片,观察其病理改变。结果左侧输尿管不全梗阻后,左肾皮、髓质的BF、BV值持续下降,4组间相比差异均有统计学意义(P<0.05)。梗阻解除后,梗阻1周组左肾皮、髓质的BF、BV值较梗阻前均有明显上升,与梗阻解除前相比差异有统计学意义(P<0.05);梗阻3周组左肾皮、髓质BF、BV值与梗阻解除前相比差异无统计学意义(P>0.05),与对照组相比差异有统计学意义(P<0.05)。梗阻5周组左肾皮、髓质的BF、BV值有所下降,与梗阻解除前和对照组相比差异均有统计学意义(P<0.05)。梗阻时间越长,梗阻解除后病理改变越重。结论MSCT不仅能提供肾脏形态学信息而且能提供功能状态信息。MSCT灌注成像在肾功能恢复的评价中有一定价值。

Objective To evaluate the value of multi-slice spiral computed tomography （MSCT） perfusion imaging for evaluating the restoration of renal function of hydronephrotic kidneys in rabbits with unilateral partial ureteric obstruction. Methods Twenty-four healthy adult male rabbits were involved in the study, aged more than 8 weeks and weighed 2.0 - 3.0 kg. Six were selected at random as controls. The other eighteen were induced to establish the partial obstruction model of left ureter, and were randomized into 3 groups according to different obstruction time： 1 week group（ n = 6）, 3 week group（ n = 6）, 5 week group（ h = 6）, and then all rabbits were performed MSCT scanning. After the obstruction was released, the model rabbits were fed for 3 months and then performed MSCT scanning. The histological changes were observed at different obstruction time by HE. Results After partial ureteric obstruction, blood flow （BF） and blood volume（BV） of the left renal cortex and medulla gradually decreased, and there was significant difference between 4 groups （ P 〈 0.05 ）. BF and BV value of left renal cortex and medulla in t week group increased significantly after the release of obstruction（ P 〈 0.05 ）, but no significant difference was found between in 1 week group and control group（ P 〉 0.05 ）. BF and BV value of left renal cortex and medulla in 3 week group showed no significant change after the release of obstruction （ P 〉 0.05 ）, but significant lower than in control group. BF and BV value of left renal cortex and medulla in 5 week group decreased significantly after the release of ob- struction（ P 〈 0.05 ） ,and significantly lower than in control group（ P 〈 0.05 ）. Histologically, there was a positive correlation between the duration of obstruction and the seriousness of pathologic changes. Conclusion MSCT perfusion imaging can provide information not only morphologically but also functionally, and it is valuable for evaluating the restoration of renal function of hydronephrotic kidney.